Septotomy Catheter For Aortic Dissection

ABSTRACT

Medical methods and devices for treating aortic dissections. A catheter-based cutting device permits cutting a septum of acute or chronic aortic dissections, in a retrograde manner. The catheter includes a base section having a central lumen therethrough, two flexible arms extending from a distal end thereof, where each arm has a channel therethrough for a passage of a guide wire. With distal ends of the two flexible arms separated, the two arms form a Y-shape with the base section. With distal ends of the two flexible arms together, the two arms have a longitudinal profile, about a periphery thereof, identical to a longitudinal profile of the base section. A non-mechanically actuated cutting component resides between the two arms in a vicinity of the distal end of the base section. The cutting component faces distally outward between the two arms with the distal ends of the two flexible arms separated.

RELATED INVENTIONS

This application is a continuation-in-part of U.S. application Ser. No.14/591,642, filed Jan. 7, 2015. This application also claims benefit ofpriority of U.S. Provisional Application Ser. No. 62/300,252, filed Feb.26, 2016. The above-identified related applications are incorporatedherein by reference.

FIELD OF THE INVENTION

The present invention relates to medical methods and devices fortreating aortic dissections; and more particularly for safely cuttingthe septum of an aortic dissection.

BACKGROUND OF THE INVENTION

Aortic dissection is an uncommon but often lethal condition where theinner layer of the aorta separates from the outer layer, creating adouble channel. The moving septum thus created disrupts the flow ofblood to the legs and viscera. Additionally, the thin outer wallresulting from the delamination of the aorta often develops into ananeurysm that may eventually rupture.

Generally, a dissection starts by a tear involving the inner layer ofthe aorta that causes the inner layer to separate from the outer layerover part of the circumference of the aorta. Upon dissection, a newchannel is formed between the separated outer and inner layers of theblood vessel wall of the aorta. This results in the aorta having twochannels instead of one. The inner layer of the blood vessel wall thathas separated is called the septum (or the flap) and separates the twochannels.

One of the two channels formed in a dissection continues to function asa blood vessel, allowing the blood to flow through it. This channel iscalled the “true lumen.” The newly formed second channel through whichblood also flows is called the “false lumen.” The true and false lumenscommunicate proximally through a proximal tear and distally through oneor possibly various existing distal tears. In some dissections, there isno distal tear.

A dissection which involves the thoracic aorta is called a “thoracicaortic dissection.” There are two types. Type A dissections involve adissection in the ascending aorta, while type B dissections involve anysegment of the descending aorta. Type A dissections require immediatesurgery. Management of type B dissections is the subject of controversy.Some doctors advocate temporary medical management, while othersadvocate immediate stent-grafting. In cases where the septum is blockingan opening of a major artery supplying the viscera or the leg, urgentsurgery may be required, and may be limited to a resection of part ofthe septum (fenestration) providing communication between the true andthe false lumens. In a few cases, this needed communication can beachieved by perforating the septum and enlarging the resultingperforation with a balloon (balloon fenestration).

A variation of the balloon fenestration involves inserting and advancingtwo wires through the false and true lumen to a proximal point, andlinking the two wires in some fashion to cut the septum with theresulting wire loop. This variation lacks control of the site and of thelength of the tearing maneuver. These attempts have been complicated byanecdotal reports of high pressure of the false lumen channel withcollapse of the true lumen and by detachment and folding of the septum,obstructing the outflow of the aorta.

One of the wires should be advanced into the true lumen, the other intothe false lumen. Entering the false lumen would be easy if both lumensreach down to the femoral artery puncture site. If the false lumen endsproximal to the femoral artery, the false lumen could be engaged bypenetrating the orifice of communication between the true and the falselumen, or by puncturing the septum as distally as possible, inserting awire in the false lumen and dilating the orifice with a balloon to allowthe septotomy cutter to engage the septum at this point. Both wiresshould come out of the body through the same orifice, either a cut-downin the common femoral artery or a sheath inserted in it.

Catheter based cutting methods and tools for aortic dissections arefound in Bliss, US 2011/0118769. Bliss primarily teaches use of amovable cutting blade, where a U-shaped or hooked tool penetrates aseptum, then hooks and cuts the septum in a proximal to distal directionby retracting a portion or entirety of the catheter, or by distallytranslating the cutting blade relative to the septum. The cutting of aseptum of a aortic dissection, in a proximal to distal direction, isproblematic. This type of cutting, by the pulling of the septum in adistal direction, using a fixed or movable blade, may result in suddencollapse of the true lumen with catastrophic consequences. Safe divisionof the septum requires distal to proximal cutting.

Bliss does suggest one embodiment of a catheter based cutting deviceintended to operate in a retrograde manner (i.e., cutting the septumfrom distal to proximal along the aortic dissection). The embodiment hasfixed, passive, cutting blade fashioned from a small, standard surgicalknife (razor blade) intended to be pushed proximally against the septumby an inner tubular component (actuator) of the catheter. This passivecutting blade does not permit a controlled septotomy. The actuator actsas a telescopic mechanism by sliding inside an outer tubular componentof the catheter. The coaxial catheter system extends the length of thecatheter and creates substantial friction during advancement of thecatheter within the blood vessel. The friction naturally increases withany increase in diameter of the two tubular components. A catheter withinner and outer tubular components functioning telescopically does nothave the flexibility to navigate the bends of the arterial system and,if some bending has been achieved, the friction between the two tubularcomponents would increase dramatically. Further, the embodimentdisclosed includes a distal end having a fixed “Y” assembly. Astationary cutting blade (razor blade) is adhered between diverging endsof two tubular components (or fixed arms) in a Y-shape. The resultantlyimmobile, Y-shaped distal end is a substantially large assembly forintroduction into (and maneuverability within) a blood vessel. Further,maneuverability and control of the cutting assembly at the septum,during septum cutting, and the required pushing of a fixed, passiveblade against the septum, makes this embodiment inoperable.

What is needed is a catheter based cutting device operable in aretrograde manner, having a cutting assembly and cutting component thatcontrols the site and length of the septum cut in both acute and chronicaortic dissection. In acute dissections, the device would equalizepressure between the true and the false lumens, potentially avoidingdevelopment of an aneurysm, as well as correcting malperfusion of theviscera or legs. Acute aortic dissections often require only a fewcentimeters of septum division to equalize pressure between the lumens,and to provide low resistance outflow of both lumens to avoiddevelopment of aneurysmal dilatation of the false lumen (e.g., 5-15 cmin the instance of cutting from the level of the aortic bifurcation tobelow the renal arteries). In chronic dissections, where differentviscera may be perfused by either lumen, a cutting device is needed toconvert the double lumen into a single one, where cutting the fibrousseptum permits insertion of a branched endograft in a manner similar tothat used in thoracoabdominal aneurysms. Also needed is a catheter basedcutting device having no mechanical actuator, providing small profileconstruction, where the cutting component is an electrode or a fiberdelivering energy that cuts the septum upon placement, without need fora mechanical push mechanism. As a result, the catheter can have a smalldiameter and increased flexibility which facilitates advancement of thecatheter through a tortuous aorta.

SUMMARY OF THE INVENTION

The present invention solve the problems noted above, providingcatheter-based cutting methods and devices operable in a retrogrademanner (distal to proximal cutting), that controls the site and lengthof the septum cut in both acute and chronic aortic dissection. In acutedissection, the present catheter equalizes pressure between the true andfalse lumens, potentially avoiding the development of an aneurysm, aswell as correcting malperfusion of the viscera or legs. In chronicdissections, where different viscera may be perfused by either lumen,the present catheter converts the double lumen into a single one, wherecutting the fibrous septum permits insertion of a branched endograft ina manner similar to that used in thoracoabdominal aneurysms. The presentcatheter has no mechanical actuator and hence can be constructed withsmall profile. As a result, the present catheter has a small diameterwith increased flexibility which facilitates advancement throughtortuous aorta.

The catheter of the present invention avoids the need for a mechanicalactuator which would need to be operated from the entry point of thecatheter to its end, usually about 70-80 cm away, and allows theconstruction of a cutting catheter with a low profile since it does notneed rigid mechanical actuators for the mechanical blade. The presentcatheter has the flexibility needed to accommodate the curves of theaortic and iliac arteries system. The bifid end of the catheter, whenintroduced, is collapsed and has the same diameter as the rest of thecatheter. The two arms of the catheter only open when the wires thatguide them diverge after encountering the lower end of the septum.

The present invention provides catheter-based cutting methods anddevices operable to cut the septum of an aortic dissection (septotomy),whether the dissection is acute or chronic. The invention involves aseptotomy catheter having a base section with a pair of bifid armsextending from a distal end of the base section. The catheter uses guidewires that extend through and beyond the arms to guide the septotomycatheter such that an area defined by a vertex formed by the two armsand base section of the catheter will engage a septum when the catheteris advanced, in a retrograde manner, in a blood vessel. At the vertex,where an end of the septum is engaged, a cutting component of thecatheter cuts the septum as the catheter is proximally advanced usingguide wires as essentially parallel rails.

The present invention includes various embodiments. In at least oneembodiment, a septotomy catheter is provided that includes a basesection having a central lumen therethrough, two flexible arms extendingfrom a distal end of the base section, where each arm has a channeltherethrough for a passage of a guide wire. With distal ends of the twoflexible arms separated, the two arms form a Y-shape with the basesection. With distal ends of the two flexible arms together, the twoarms have a longitudinal profile, about a periphery thereof, identicalto a longitudinal profile of the base section. The catheter alsoincludes a non-mechanically actuated cutting component residing betweenthe two arms in a vicinity of the distal end of the base section. Thecutting component faces distally outward between the two arms with thedistal ends of the two flexible arms separated.

In one or more embodiments, the cutting component spans the two flexiblearms when the arms are separated. In these embodiments, the cuttingcomponent resides perpendicularly to a longitudinal axis of thecatheter.

In one or more embodiments, the two flexible arms each further comprisea notch therein, each notch housing a respective end of the cuttingcomponent, each notch providing that the respective end of the cuttingcomponent is not exposed outside the catheter when the two arms areseparated. With distal ends of the two arms together, the cathetercompletely houses the cutting component therein, whereby no part of thecutting component is exposed outside the catheter.

In one embodiment, the cutting component is an electrode spanning thetwo flexible arms when separated, residing perpendicularly to alongitudinal axis of the catheter. The electrode is energized byradio-frequency (RF) current. The electrode can be a wire, bar, rod,flat sheet, blade or plate. If a flat sheet, plate or blade, theelectrode can be entirely insulated except for a most distal portionthereof which is uninsulated. The insulation can be a medical gradeepoxy. The uninsulated portion of the flat sheet, plate or blade, alonga distal edge thereof, might resemble a wire or rod, or sharpened tipthin blade. The uninsulated portion spans the two flexible arms whenseparated, residing perpendicularly to the longitudinal axis of thecatheter. If a flat sheet, plate or blade, the longitudinal, insulatedsides would reside inside respective notches of the two arms.

The radio-frequency (RF) current can be provided by a wire residingwithin the central lumen of the base section. The RF energization can bemonopolar or bipolar.

In another embodiment, the cutting component of the catheter is laserlight generated by an excimer laser. An excimer laser fiber can residewithin the central lumen of the base section. The two bifid arms, withdistal ends together, completely house the excimer laser fiber therein,whereby no part of the cutting component is exposed outside thecatheter. In this embodiment, if notches are included in the two arms,each notch would house, and/or would be configured to provideunrestrained operation of, and laser light emission from, a distal endof the excimer laser fiber, in a vicinity of the base section, when thetwo arms are separated.

In another embodiment, the cutting component is an ultrasonic cuttingblade, having a cutting edge facing distally and spanning the twoflexible arms when the arms are separated. An ultrasonic static motorcan reside within the base section, along the central lumen thereof. Thecutting blade cuts by ultrasound energy and its high frequency vibrationcan be delivered by a minute piezoelectric ceramic energized through athin electrical wire passing through the central lumen of the basesection.

In still another embodiment, the catheter can further include two basesection channels extending through an entirety of the base section. Thebase section channels are parallel to the central lumen, with each basesection channel communicating with a respective channel of the arm toprovide passage of two guide wires, one guide wire per channel, throughan entirety of the catheter.

A method of treating an aortic dissection is also provided, using anembodiment of the septotomy catheter. The method involves inserting twoguide wires into an arterial system. Moving the two guide wiresproximally, into a descending aorta, where the two guide wires aresubstantially parallel to one another and spaced apart a distance. Aseptum of the aortic dissection is then penetrated, with a first of thetwo guide wires, into a false lumen of the aortic dissection, distal ofa proximal tear of the aortic dissection, at a certain location. At thiscertain penetration location, the guide wires become more separated fromone another. The two guide wires are moved further proximally, towardthe proximal tear, with the first guide wire in the false lumen and asecond guide wire in a true lumen of the aortic dissection, with septumof the aortic dissection between the two guide wires. The guide wiresremain spaced apart, proximal of the certain location of septumpenetration, at least the distance or greater;

The method then includes inserting a distal end of the septotomycatheter over the guide wires, one guide wire in each of the twochannels of the septotomy catheter. The septotomy catheter is movedproximally in the arterial system, with guide wires passingtherethrough, toward the aortic dissection, the septotomy cathetertracking the substantially parallel guide wires and remaining closed,with the distal ends of the arms together, completely housing thecutting component therein, whereby no part of the cutting component isexposed outside the catheter. The septum of the aortic dissection isthen penetrated with one of the flexible arms, into the false lumenthereof, at the certain location, while the one of the flexible armstracks the first guide wire into the false lumen and then proximallythereof and the other of the flexible arms tracks the second guide wireproximally in the true lumen. At the certain location, the distal endsof the two flexible arms separate, forming a Y-shape with the basesection to expose the cutting component outside the catheter, frombetween the flexible arms, with the cutting component facing distallyrelative to the catheter. The septotomy catheter is moved furtherproximally, with arms separated. The catheter receives the septumbetween the separated arms, where the separated arms, with cathetermoving proximally, direct a distal end of the septum into the cuttingcomponent. The septum is cut a desired distance determined by furtherproximal movement of the catheter. During the method, the cuttingcomponent is energized only upon receipt of the septum between theseparated arms, with septum in close proximity to the cutting component.

BRIEF DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

The present invention will be better understood with reference to thefollowing description taken in combination with the drawings. For thepurpose of illustration, there are shown in the drawings certainembodiments of the present invention. In the drawings, like numeralsindicate like elements throughout. It should be understood, however,that the invention is not limited to the precise arrangements,dimensions, and instruments shown:

FIG. 1 illustrates a view of a catheter within a blood vessel (the bloodvessel shown in section), the catheter traversing over guidewires andshown in a closed, non-cutting configuration, in accordance with oneembodiment of the present invention;

FIG. 2 illustrates a view of the catheter of FIG. 1, still within theblood vessel and traversing guidewires, now with distal arms opening andseparated, while guided by the guide wires, providing that a cuttingcomponent within the arms receive and engage an edge end of a septum;

FIG. 3 illustrates a cross-section of one embodiment of the catheter ofthe present invention, where the cutting component is a RF energizedelectrode, and further showing internal components and operation of thecatheter;

FIG. 4 illustrates a cross-section of another embodiment of the catheterof the present invention, where the cutting component is a ultrasoundenergized cutting blade, and further showing internal components andoperation of the catheter;

FIG. 5 illustrates a cross-section of a Type B aortic dissection,showing guide wire insertion (one guide wire in a true lumen and oneguide wire in a false lumen), with an embodiment of the catheter of thepresent invention traversing over the guidewires, the catheter shown ina closed, non-cutting configuration;

FIG. 6 illustrates a cross-section of a Type B aortic dissection, againshowing guide wires inserted, with an embodiment of the catheter of thepresent invention tracking the guidewires, the catheter now with distalarms separated, while guided by the guide wires, revealing a cuttingcomponent therein, the arms receiving for cutting a septum of the aorticdissection;

FIG. 7 illustrates an alternative feature of a catheter embodiment ofthe present invention, and further showing (via see-through armportions) aspects of the present invention; and

FIG. 8 illustrates an alternative feature of a catheter embodiment ofthe present invention, showing flexible wings extending axially from abase section of the catheter, proximal to the cutting component, toassist alignment of the catheter, and the cutting component, within theaorta and toward a center axis of the septum.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

The catheter of the present invention is used for cutting a septum in anaortic dissection, whether acute (where the septum is thin and mobile)or chronic (where the septum is thick and immobile). The catheter can,for instance, be inserted into a dissected aorta in the treatment ofType B thoracic aortic dissections. The figures show the device asdescribed below, and use the same reference numeral for the same elementin each drawing. When referring to the catheter of the presentinvention, an end of the catheter remaining outside the patient isreferred to as the proximal end, and an end of the catheter comprisingthe cutting assembly is referred to as the distal end. When referring tothe aortic dissection, the septum thereof, and surgical activity aroundthe septum, an end of the dissection closest to the heart is referred toas the proximal end, and an end furthest from the heart is referred toas the distal end (bottom of page of FIGS. 6 and 7).

FIGS. 1 and 2 show a septotomy catheter 10 within a blood vessel,typically an aorta A. The catheter 10 has a base section 12 from which apair of flexible arms (or tips) 14, 16 extend. FIG. 1 shows the catheter10 being advanced in the aorta A in a proximal direction, from a femoralartery toward the heart. FIG. 2 shows the catheter 10 after advancementin the Aorta A and upon separation of the flexible arms 14, 16 resultingin a distal end of the catheter 10 assuming a general Y-shape. FIGS. 3and 4 illustrate embodiments of the catheter 10 in cross-section, bettershowing internal components and operation of the catheter.

Located at a vertex 18 of the catheter 10 is a cutting assembly 20,formed at the distal end of the base section 12 and the proximal end ofthe two arms 14, 16. The cutting assembly 20 is preferablynon-mechanically actuated (e.g., not micro-scissors, a moving blade, ajigsaw or serrated wires). A septum cutting component 22 of the cuttingassembly 20 spans the vertex 18 of the catheter 10, perpendicular to alongitudinal axis of the catheter 10. Each end of the septum cuttingcomponent 22, and also a respective adjacent, longitudinal side of thecutting assembly 20 or cutting component 22, resides inside a notch ortrough 24 within each of the two arms 14, 16. The notch 24 provides thatthe cutting assembly 20, and particularly the end of the septum cuttingcomponent 22, are protected by (e.g., completely enclosed within) thenotches 24 and by the closure of the two arms 14, 16 (as shown in FIG.1). When open, the arms 14, 16 receive the septum S and direct theseptum S to the cutting component 22. The catheter 10 is snuglyconfigured, with each end of the perpendicularly spanning cuttingcomponent 22 nestled within the notch 24 of each arm 14, 16, so that theseptum S, if abutting an arm 14, 16, during use, is movably directedalong the arm to the cutting component 22. The septum does not snag atthe juncture of the cutting component 22 and respective arm 14, 16, dueto the direct transition of arm 14, 16 to cutting component 22. Overall,a profile of the closed, cutting end of the catheter 10 (i.e., thedistal end of the catheter 10, including the two arms 14, 16 and thevertex 18) has the same profile as the remaining base section 12 of thecatheter 10 (as shown in FIG. 1).

In one embodiment, the cutting assembly 20 is radio-frequency (RF)energized, and the septum cutting component 22 is an electrode. Theelectrode can be a wire, bar, rod, sheet, blade or plate. If aconductive sheet or plate, much of the sheet or plate can be insulated(except for a most distal portion thereof). A remaining, uninsulatedportion of the electrode would likely resemble a wire, bar or rodspanning the vertex 18 of the catheter 10, perpendicular to thelongitudinal axis of the catheter 10. In this instance, longitudinalsides of the sheet or plate would reside inside the notch or trough 24within each of the two arms 14, 16.

The RF energization can be monopolar or bipolar. In monopolar use, theactive electrode 22 is placed at the cutting site, and a returnelectrode pad is attached to the patient (not shown). High frequencyelectrical current flows from a generator (not shown), to the electrode22, through to target tissue, to the patient return pad, and back to thegenerator. The catheter 10 includes a central lumen 26 for thetraversing therethrough of a RF current wire 28 (as shown in FIG. 3). Ina bipolar embodiment, usually lower voltages are employed, thereby lessenergy is required. A return electrode or pad must therefore be muchcloser to the active electrode, and to the cutting site. RF current isrestricted to tissue between the active and return electrodes, therebygiving better control over the targeted area and preventing possiblecurrent damage to surrounding sensitive tissue.

In another embodiment, the cutting assembly 20 employs an ultrasonicstatic motor 30 and the septum cutting component 22 is an ultrasoniccutting blade (as shown in FIG. 4). The ultrasonic motor 30 can take theform of a piezoelectric device (ceramic PTZ disks) connected to cuttingcomponent 22, energized through a thin conductor (wire) imbedded in thecatheter that delivers electric current. The ultrasonic motor 30 ispreferably housed within base section 2. The ultrasonic static motortransforms electrical voltage into high-frequency (approximately 50,000Hertz) vibration, and the vibration is transmitted to the cuttingcomponent 22 and causes the blade to cut through the septum on contact.

In still another embodiment, the cutting assembly 20 employs an excimerlaser (or exciplex laser), where the septum cutting component 22 is thegenerated laser light in the ultraviolet range (not shown). The excimerlaser fiber travels through the central lumen 26 of the catheter 10. Thehigh-power ultraviolet output of excimer lasers are useful and efficientfor delicate surgeries, as the laser can make clean, precise cuts intissue.

As better illustrated in FIGS. 3 and 4, but also shown in FIGS. 1 and 2,a pair of guide wires 32 traverse the catheter 10 through channels 34,one guide wire 32 per channel 34. Each guide wire 32 passes through arespective channel 34 in the base section 12 and then separate, with oneguide wire 32 traversing through one channel 34 in each of the arms 14,16. Preferably, the guide wires 32 traverse channels 34 of the catheter10 linearly, proximally to distally (relative to the catheter) in asingle direction (i.e., no looping or doubling back).

FIGS. 5 and 6 illustrate a cross-section of a Type B aortic dissection,a method of treating aortic dissection, a method for septum cutting, andfor use of the catheter 10. Shown are an ascending aorta AA, descendingaorta DA, femoral artery FA, renal arteries RA, septum S, proximal tearPT, true lumen TL, and false lumen FL. When referring to the aorticdissection, the septum S thereof, and surgical activity involving theseptum S, an end of the dissection closest to the heart is referred toas the proximal end, and an end furthest from the heart is referred toas the distal end (bottom of page).

Now referring to FIGS. 5 and 6, the guide wires 32 are first insertedinto the blood vessel, at the femoral artery, and advanced in a proximaldirection, along the aorta A, toward a point of aortic dissection. Sincethe guide wires 32 are constrained by the blood vessel walls A, theguide wires 32 are roughly parallel to each other, and parallel to theaxis of the blood vessel. Upon reaching a point of aortic dissection,one guide wire 32 is inserted (penetrated) through a septum S of theaortic dissection, into a false lumen FL thereof. The other guide wire32 is equally advanced, but remains in a true lumen TL of the aorta(alongside the dissection).

Thus, both guide wires 32 have entered the femoral artery FA through thesame puncture or through an introducer sheath inserted into the artery.Both guidewires 32 are fully advanced within the aorta A to a finallocation, with one guide wire 32 inserted through the septum S into thefalse lumen FL and one guide wire 32 in the true lumen TL. A finallocation of the guide wires 32 extend beyond a point where a cutting ofthe septum will cease (with one guide wire 32 on each side of the septumS along the dissection). The proximal ends of the guidewires 32,remaining outside the body, are then fed into the channel(s) 34 at adistal end of the catheter 10. The catheter 10 is inserted in the sheathand pushed along the vessel, tracking and moving along (over) the guidewires 32, as the guide wires 32 pass through the channels 34. As thecatheter 10 is advanced within the aorta A, along the parallel guidewires 18, prior to reaching the aortic dissection, the catheter 10remains in a closed, non-cutting configuration, with cutting component22 non-exposed (as shown in FIGS. 1 and 5). Shortly, the catheter 10approaches a distal end of the septum S of the aortic dissection, at thepoint where one guide wire 18 penetrates through the septum S.

The arms 14, 16 of the catheter 10 do not diverge into a Y-shape (andthus revealing the cutting component 22) until the guide wires 32separate at the lower edge (distal end) of the septum S (at the pointwhere one guide wire 18 penetrates through the septum S) As shown inFIG. 6, the catheter 10 tracks the guide wires 32, the arms 14, 16separate, forming a Y-shape, with one arm 14 disposed in the true lumenTL and another arm 16 disposed in the false lumen FL. The septum S isnow located between the arms 14, 16, and is directed by the arms 14, 16into the cutting component 22 while the catheter 10 is continuallyadvanced toward the heart (in a proximal direction relative to thedissection).

Referring to FIG. 6, as the catheter 10 continues proximal advancement(by continually tracking the guide wires 32 previously placed in theaorta A), the cutting component 22 proximally moves and cuts along thelength of septum S. The catheter 10 follows the guide wires 32, therebydirecting the path (and the opening and closing) of the arms 14, 16.When open, the arms 14, 16 receive the septum S and direct the septum Sto the cutting component 22. In all embodiments, the catheter 10 issnugly configured, with each end of the cutting component 22 nestledwithin the notch 24 of each arm 14, 16, so that the septum S, ifabutting an arm 14, 16, is movably directed along the arm to the cuttingcomponent 22. The septum does not snag at the juncture of the cuttingcomponent 22 and respective arm 14, 16.

As noted, acute aortic dissections often require only a few centimetersof septum division to equalize pressure between the lumens, and toprovide low resistance outflow of both lumens to avoid development ofaneurysmal dilatation of the false lumen (e.g., 5-15 cm in the instanceof cutting from the level of the aortic bifurcation to below the renalarteries). FIGS. 5 and 6 illustrate an instance of aortic dissectionwhere guide wire 32 penetration of the septum S occurs, generally, atthe femoral or external iliac level C1 (i.e., cutting start point C1).Cutting of the septum S begins at point C1 and ceases below the renalarteries RA, at C2 (i.e., cutting end point C2). In chronic dissections,where different viscera may be perfused by either lumen, septum cuttingis needed to convert the double lumen into a single one, and cutting thefibrous septum may be required to the proximal tear PT.

After a suitable length of septum S cutting is complete, the cuttingcomponent is de-energized, and the catheter 10 is withdrawn, in a distaldirection, from the blood vessel. Any remaining septum S is undisturbed.As noted, the methods and device of the present invention teach septum Scutting in a retrograde manner (from distal to proximal along the aorticdissection), which is the only safe, effective way to divide the septumS. Dividing a septum from a proximal to distal point, by pulling orretraction of a catheter device, may result in sudden collapse of thetrue lumen, sometimes with catastrophic consequences.

FIG. 7 illustrates an alternative embodiment of the catheter 10, whereeach of the guide wires 32 extend and traverse through a longitudinalchannel 34 residing only in a respective arm 14, 16. To betterillustrate this alternative feature, and other features within the arms14, 16, FIG. 7 is provides see-through capability of the arms 14, 16 ofthe catheter 10.

In the FIG. 7 embodiment, each channel 34 (and therefore each guide wire32 during catheter use) exits the respective arm 14, 16 at a proximalend 36 thereof, in a vicinity of the cutting component 22. The guidewires 32 are thereafter located exterior to the catheter 10, alongsideand parallel to the base section 2. The channel 34 of this alternativeembodiment may exit the proximal end 36 of the arm 14, 16 at a locationlongitudinally distal to the cutting component 22, longitudinallyproximal to the cutting component 22, and/or at an angle relative to thelongitudinal axis of the catheter 10, to ensure that the catheter 10,when in a closed, non-cutting configuration (with cutting component 22non-exposed), has arms 14, 16 completely abutting one another (similarto that shown in FIG. 1).

FIG. 7 also illustrates respective notches 24 in each arm 14, 16 of thecatheter 10, showing well-defined longitudinal wells or troughs thathouse a respective end of each cutting component 22, and that houserespective sides of each cutting component 22 (or that house insulatedportions of the cutting component, or that house and insulate wiresfeeding an electrode cutting component 22, all comprised within thecutting assembly 20).

FIG. 8 illustrates another alternative feature of the catheter 10. Adistal end of the catheter 10 can include one or more flexible wings 40,preferably small, on an outer aspect of the base section 12, proximal tothe cutting assembly 20, to better align the catheter 10, and thecutting component 22, within the aorta A and toward a center axis of theseptum S. Further, and preferably smaller, flexible wings 40 couldextend from the arms 14, 16. The flexible wings 40 may have a fixedshape, or may be collapsible, providing that the wings 40 can be carriedon or inside the catheter 10 until the diameter of the lumen into whichthe catheter 10 is advanced permits its passive extending (orun-flexing). The flexible wings 40, illustrated in FIG. 8, form of aloop made of the material similar to that of the catheter 10. Thisalternative feature can be used when the catheter 10 is introduced intothe blood vessel by insertion through a hollow outer catheter,introducer element, or similar body. In this instance, when the catheter10 protrudes from the introducer element, the flexible wings 40 expand(open or axially extend). When the catheter 10 is withdrawn from theblood vessel, back into the introducer element, the wings 40 would foldforward onto the outer walls of the base section 12 or the arms 14, 16.

These and other advantages of the present invention will be apparent tothose skilled in the art from the foregoing specification. Accordingly,it will be recognized by those skilled in the art that changes ormodifications may be made to the above-described embodiments withoutdeparting from the broad inventive concepts of the invention. Forexample, features detailed as included in certain specific embodimentsabove are recognized as interchangeable and possibly included in otherdetailed embodiments. Specific dimensions of any particular embodimentare described for illustration purposes only. It should therefore beunderstood that this invention is not limited to the particularembodiments described herein, but is intended to include all changes andmodifications that are within the scope and spirit of the invention.

What is claimed is:
 1. A septotomy catheter, comprising: a base sectionhaving a central lumen therethrough; two flexible arms extending from adistal end of the base section, each arm having a channel therethroughfor a passage of a guide wire, wherein: with distal ends of the twoflexible arms separated, the two arms form a Y-shape with the basesection; with distal ends of the two flexible arms together, the twoarms have a longitudinal profile, about a periphery thereof, identicalto a longitudinal profile of the base section; a cutting componentresiding between the two arms adjacent to the distal end of the basesection, wherein: the cutting component faces distally and spans the twoflexible arms when separated, residing perpendicularly to a longitudinalaxis of the catheter; the two arms each further comprise a notchtherein, each notch housing a respective end of the cutting component,each notch providing that the respective end of the cutting component isnot exposed outside the catheter when the two arms are separated; thetwo arms, with distal ends together, completely house the cuttingcomponent therein, whereby no part of the cutting component is exposedoutside the catheter.
 2. The catheter of claim 1, wherein the cuttingcomponent is non-mechanically actuated or energized.
 3. The catheter ofclaim 1, wherein the cutting component is an electrode energized byradio-frequency (RF) current.
 4. The catheter of claim 3, wherein theelectrode is a wire.
 5. The catheter of claim 3, wherein the electrodeis a flat plate or blade, entirely insulated except for a most distalportion thereof which is uninsulated, the uninsulated portion resemblinga wire or rod spanning the two flexible arms when separated, residingperpendicularly to the longitudinal axis of the catheter.
 6. Thecatheter of claim 5, wherein longitudinal, insulated sides of the flatplate or blade reside inside respective notches of the two arms.
 7. Thecatheter of claim 3, wherein the radio-frequency (RF) current isprovided by a wire residing within the central lumen of the basesection.
 8. The catheter of claim 3, wherein the RF energization ismonopolar.
 9. The catheter of claim 3, wherein the RF energization isbipolar.
 10. The catheter of claim 1, wherein the cutting component isan ultrasonic cutting blade, having a cutting edge facing distally andspanning the two flexible arms when the arms are separated.
 11. Thecatheter of claim 10, further comprising an ultrasonic static motorresiding within the base section, along the central lumen thereof. 12.The catheter of claim 1, further comprising two base section channelsextending through an entirety of the base section, the base sectionchannels being parallel to the central lumen, wherein each base sectionchannel communicates with a respective channel of the arm to providepassage of two guide wires, one guide wire per channel, through anentirety of the catheter.
 13. A septotomy catheter, comprising: a basesection having a central lumen therethrough; two flexible arms extendingfrom a distal end of the base section, each arm having a channeltherethrough for a passage of a guide wire, wherein: with distal ends ofthe two flexible arms separated, the two arms form a Y-shape with thebase section; with distal ends of the two flexible arms together, thetwo arms have a longitudinal profile, about a periphery thereof,identical to a longitudinal profile of the base section; a cuttingcomponent residing at a distal end of the base section, facing distallyoutward between the two arms with the distal ends of the two flexiblearms separated, wherein: the cutting component is laser light generatedby an excimer laser; an excimer laser fiber resides with the centrallumen of the base section. the two arms, with distal ends together,completely house the excimer laser fiber therein, whereby no part of thecutting component is exposed outside the catheter.
 14. The catheter ofclaim 13, wherein the two arms each further comprise a notch therein,each notch housing, or providing unrestrained operation of, and lightemission from, a distal end of a tip of the excimer laser fiber.
 15. Aseptotomy catheter, comprising: a base section having a central lumentherethrough; two flexible arms extending from a distal end of the basesection, each arm having a channel therethrough for a passage of a guidewire, wherein: with distal ends of the two flexible arms separated, thetwo arms form a Y-shape with the base section; with distal ends of thetwo flexible arms together, the two arms have a longitudinal profile,about a periphery thereof, identical to a longitudinal profile of thebase section; and a non-mechanically actuated cutting component residingbetween the two arms in a vicinity of the distal end of the basesection, wherein the cutting component is an electrode spanning the twoflexible arms when separated, residing perpendicularly to a longitudinalaxis of the catheter.
 16. The catheter of claim 15, wherein the two armseach further comprise a notch therein, each notch housing a respectiveend of the electrode, each notch providing that the respective end ofthe electrode is not exposed outside the catheter when the two arms areseparated, wherein the two arms, with distal ends together, completelyhouse the electrode therein, whereby no part of the electrode is exposedoutside the catheter.
 17. The catheter of claim 15, wherein theelectrode is energized by radio-frequency (RF) current.
 18. The catheterof claim 15, further comprising one or more flexible wings axiallyexpandable and collapsible from an outer aspect of the catheter, whereinthe one or more wings are carried in a collapsed state until a diameterof a vessel into which the catheter is advanced permits passiveexpansion against inner walls of the vessel, whereby the wings align thecatheter and the cutting component within the vessel.
 19. A method oftreating an aortic dissection, comprising the steps of: providing theseptotomy catheter of claim 1, 13 or 15; inserting two guide wires intoan arterial system; moving the two guide wires proximally, into adescending aorta, wherein the guide wires are substantially parallel toone another and spaced apart a distance; penetrating a septum of theaortic dissection, into a false lumen thereof, distal of a proximal tearof the aortic dissection, at a certain location, with a first of the twoguide wires, wherein the guide wires become more separated from oneanother at the certain location of septum penetration; continuing tomove the guide wires proximally, toward the proximal tear, with thefirst guide wire in the false lumen and a second guide wire in a truelumen of the aortic dissection, with septum of the aortic dissectionbetween the two guide wires, wherein the guide wires remain spacedapart, proximal of the certain location of septum penetration, at leastthe distance or greater; inserting a distal end of the septotomycatheter over the guide wires, one guide wire in each of the twochannels of the septotomy catheter; moving the septotomy catheterproximally in the arterial system, with guide wires passingtherethrough, toward the aortic dissection, the septotomy cathetertracking the substantially parallel guide wires and remaining closed,with the distal ends of the arms together, completely housing thecutting component therein, whereby no part of the cutting component isexposed outside the catheter; penetrating the septum of the aorticdissection, into the false lumen thereof, at the certain location, withone of the flexible arms, while the one of the flexible arms tracks thefirst guide wire into the false lumen and then proximally thereof, theother of the flexible arms tracking the second guide wire proximally inthe true lumen, wherein the distal ends of the two flexible armsseparate, forming a Y-shape with the base section to expose the cuttingcomponent outside the catheter, from between the flexible arms, with thecutting component facing distally relative to the catheter; and movingthe septotomy catheter further proximally, with arms separated, theseptotomy catheter receiving the septum between the separated arms,where the separated arms, with catheter moving proximally, direct adistal end of the penetrated septum into the cutting component, wherebythe septum is cut a desired distance determined by further proximalmovement of the catheter.
 20. The method of claim 19, wherein thecutting component is energized only upon receipt of the septum betweenthe separated arms, with septum in close proximity to the cuttingcomponent.